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35 cm in total length collected on a nature reserve in Singapore (Subaraj, 2008; Table
4.1 ). The bite was protracted with penetration by a single enlarged maxillary tooth.
He reported immediate local effects (paresthesia, mild bleeding, and pain) as well as
concerning systemic symptoms including giddiness, “massive headache,” “collapse,”
tachycardia, diaphoresis, dyspnea, and chest pain (Subaraj, 2008; Table 4.1 ). Speech
difficulties and mild cognitive dysfunction persisted for almost 24 h. Although the
author was attended by paramedics called by his companions, he refused transport to
hospital or formal medical review (Subaraj, 2008).
This report is suggestive of an autonomic (anxiety-driven) response to this incident
(see Section 4.5.2). The author indicated that M. rhodomelas was “not known to be
venomous” and allowed the snake to maintain a grasp during the bite until it became
increasingly painful. All of the symptoms/signs suggesting systemic effects spontane-
ously resolved in less than 24 h. This case lacks any objective assessment apart from
a borderline tachycardia (pulse 100/min) measured by an ambulance paramedic.
Therefore, it cannot be accepted as any evidence of medical risk from this species. As
the data are insufficient to provide a thorough risk assessment of M. rhodomelas , care-
ful handling of these snakes is advisable until further documentation is available.
Conclusions and Recommendations
Case reports describing bites from colubroids of unknown medical importance may
include descriptions of serious symptoms/signs that lack a causative linkage with the
bite, or with envenomation. It is imperative that these cases be analyzed using an evi-
dence-based approach. Common, alternative etiologies should be carefully considered.
Case reports are frequently excessively subjective and carry, or imply, unsupported
speculative conclusions. A carefully formulated and clinically astute differential diag-
nosis is more likely to clarify the natural history and true etiology of the illness, as
opposed to anxiety-driven responses to a bite that may well be medically insignificant.
4.5.1.5 Insufficient or Irrelevant Documentation of History and Clinical
Features/Analysis
Many reports contain incomplete or irrelevant details with a concomitant lack of criti-
cal, clinically knowledgeable analysis. Consideration of a representative case featuring
multiple flaws illustrates the difficulty in assessing the risk assigned to a given species.
Phalotris trilineatus (Argentine black-headed snake; Plate 4.37A-C) has been
considered as a species of possible medical importance based on anecdotal evidence.
Several reports have suggested significant medical effects resulting from bites by this
species, but they have appeared in limited-circulation or institution-based, obscure
periodicals ( Table 4.1 ). In one of only two documented cases, the herpetologist
victim/author was presented with a juvenile specimen of this species after having “a
lot of barbecue and beer at lunch” (de Lema, 2007). The author was bitten while he
identified the specimen. He reported that his curiosity led him to allow a protracted
bite until a “strong growing burning sensation became unbearable,” at which time
the snake was removed (de Lema, 2007). The author eventually drove himself to
the hospital, took an unknown dose of aspirin, and reported having fairly constant
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